CMS proposes coverage updates, and a name change, for TMVR
CMS has proposed an update to its national coverage policy for transcatheter edge-to-edge repair (TEER) of the mitral valve, changing it so that patients with functional mitral regurgitation (MR) would be covered going forward. The current national coverage determination (NCD), from August 2014, only covered “symptomatic moderate-to-severe” MR.
TEER, the agency explained, is the new name being given to Transcatheter Mitral Valve Repair (TMVR) “to more precisely define the treatment.”
If finalized, TEER of the mitral valve would be covered for both symptomatic moderate-to-severe MR and severe functional MR if the patient’s symptoms remain following guideline-directed medical therapy. Patients would also need to meet certain criteria, including ischemic or non-ischemic cardiomyopathy, left ventricular ejection fraction of 20-50%, a New York Heart Association Functional Classification of Class II, II or IVa (ambulatory) and left ventricular end-systolic dimension of at least 70 mm. A “local heart team” must also determine that mitral valve surgery is not on the table as a treatment option.
“Over the last several years CMS has been closely monitoring the evolution of TEER for the mitral valve and today’s proposed decision is another example of our commitment to ensuring Medicare patients have access to the latest technology,” CMS Administrator Seema Verma said in a statement. “We recognize that patients with functional MR have limited treatment options beyond medical therapy and we believe this decision provides them with access to a new treatment option that may lead to improved health outcomes.”
The full proposed NCD is available here. Public comments are being accepted for 30 days.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.